[dropcap]I[/dropcap]t’s desk-clearing time for 2015 and time to visit some under-reported hepatitis C-related news. Hep C has been in the news quite a bit this year, mostly about the rapidly changing landscape of treating the hepatitis C virus (HCV). The new all-oral, interferon-free regimens are highly effective and well tolerated and could pave the way to eventual eradication of the virus. But cost and access to meds have become big concerns for patient advocates. And research continues into what other lifestyle choices can benefit or harm people with HCV, as well as studies showing how HCV and potentially drug-resistant strains of HCV could spread.
Who can access new meds? Not the poorest patients.
While the expense of the newest antivirals has been a concern for patients and health advocates—costs that can reach nearly six figures for a twelve-week course—much of the blame and scrutiny for unaffordability is coming down on payers.
A research team from the University of Pennsylvania published results of a study at the National Liver Conference in San Francisco that analyzed Medicaid programs in a four-state region in the mid-Atlantic. Using prescription data for 2,342 patients across Pennsylvania, New Jersey, Delaware and Maryland, the Penn research team found widespread denial of coverage requests for the most effective treatments for chronic HCV, with Medicaid programs denying nearly half of the prescriptions compared with five percent for Medicare and ten percent for commercial insurance.
The team also found that coverage for HCV meds was most often denied because the treatments were not considered a medical necessity or because the patients had tested positive for alcohol or commonly abused drugs.
The study’s lead author Vincent Lo Re III, an assistant professor at Penn’s Perelman School of Medicine, said, in a statement on the research, that Medicaid denials are creating a serious health disparity.
“Patients on Medicaid are more likely to be suffering from these infections, yet they are much more likely to be denied coverage for the drugs,” Lo Re wrote.
Buzz about caffeine
In November coffee lovers rejoiced over a new study that showed people who drank three to five cups of coffee per day had about a fifteen-percent lower risk of premature death compared to people who didn’t drink coffee. But there was some good news in another study for HCV patients who drink coffee or other caffeinated beverages.
In August the journal Clinical Gastroenterology & Hepatology reported a study showing that caffeine was associated with decreased risk of advanced hepatic fibrosis among patients with HCV.
Dr Hashem El-Serag and colleagues from Texas conducted a cross-sectional study of veterans with chronic HCV infection to evaluate the association between daily intake of caffeinated and decaffeinated coffee, tea, and soda, and level of hepatic fibrosis, based on the FibroSURE test.
Studying 910 patients with chronic HCV infection—ninety-eight percent male and thirty-eight percent with advanced hepatic fibrosis, and adjusting the models for multiple potential confounders including age, alcohol use and obesity, researchers found liver-protective effects with an average daily intake of 100 mg or more of caffeine (the equivalent of about one cup of coffee). And the team noted that caffeine from tea or soda had similar benefits for protecting from advanced fibrosis, benefits that included insulin resistance.
In a prepared statement Dr El-Serag’s team concluded that modest daily caffeine intake may protect against advanced hepatic fibrosis in men with chronic HCV infection, but cautioned that more research was needed to confirm these findings in women and in people with other chronic liver diseases.
In November a team of researchers from the University of Scotland published results tracing the spread of HCV to Scotland during World War II.
In the study published in the Journal of Virology, scientists from the MRC-University of Glasgow center for virus research and NHS virus diagnostics labs showed that HCV entered Scotland during the 1930s and 1940s, and they speculate that the virus spread to other countries through the mass treatment of soldiers in field hospitals during the war.
By examining comparing the sequence of virus strains in infected individuals across various geographical areas in Scotland, the team found that the virus showed a significant increase in the 1970s in two regions of Scotland and extensive HCV transmission across Scotland by the 1990s. In analyzing the strains emerging from Glasgow, researchers identified areas of the city involved in the spread of the virus up to the present day.
The practical purpose of pinpointing regions of Scotland that have driven the spread of HCV, the study leads say, is to help the country develop a hepatitis C action plan to prevent transmission of the virus and to monitor the emergence of drug-resistant strains.
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.